Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead...
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![Page 1: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/1.jpg)
Approach to medical liver biopsies
Dr Behrang MozayaniConsultant HistopathologistSouthmead hospitalBristol
![Page 2: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/2.jpg)
Indications for biopsy
Abnormal unexplained liver function tests
Evaluation of diagnosis, grade and stage of disease
Unexplained cholestatic liver disease FUO Suspected hepatic tumour Post transplantation
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Size of biopsy
…biopsy of at least 2-3 cm in length and 16-gauge in calibre is recommended (AASLD position paper)
Current UK standard: minimum 15mm and 6 portal tracts. Often 18 gauge
![Page 4: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/4.jpg)
Cases
Most common diagnosis Should be straight forward Not always one answer without
clinical information
![Page 5: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/5.jpg)
Case 1
68 year old female Abnormal lfts Episodes of pruritus AMA positive Raised alk phos and IgM
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diagnosis
Primary biliary cirrhosis
![Page 7: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/7.jpg)
Case 2
57 year old male Episodes of Jaundice and pruritus High alk phos, low GGT ALTs 200s Abnormal hepatic duct on MRCP
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diagnosis
Chronic large duct obstruction Wider differential
![Page 9: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/9.jpg)
Case 3
61 year old male Generally unwell ALTs 300s On hormone therapy for prostate
cancer
![Page 10: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/10.jpg)
diagnosis
Central perivenulitis/acute hepatitis
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Case 4
80 year old male Sudden onset of jaundice Acutely unwell Autoantibodies negative
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diagnosis
Acute hepatitis
![Page 13: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/13.jpg)
Case 5
25 year old male Known UC Abnormal LFTs
![Page 14: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/14.jpg)
diagnosis
Primary sclerosing cholangitis
![Page 15: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/15.jpg)
Case 6
54 year old male Ultrasound suggests cirrhosis ?cause
![Page 16: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/16.jpg)
diagnosis
Steatohepatitis and incomplete cirrhosis
![Page 17: Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol.](https://reader031.fdocuments.us/reader031/viewer/2022013115/56649dc45503460f94ab6f5a/html5/thumbnails/17.jpg)
Case 7
61 year old female Feeling tired, poor appetite ALT 500s IgG raised ANA+ Viral serology negative No drug history
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diagnosis
Autoimmune hepatitis
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Case 8
60 year old male High ferritin in work up C282Y homocygote Normal lft’s
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diagnosis
Genetic haemochromatosis
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Case 9
64 year old female Cirrhosis Heart failure Abnormal lft’s
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diagnosis
Cirrhosis ? Aetiology A1AT deficiency
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Case 10
22 year old female Abnormal lfts and fibroscan Low caeruloplasmin, high serum
copper Chromosome 13 mutation
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diagnosis
Wilson’s disease